‘Public sector must play a dominant role in health care’

AComprehensive critique of republic of india’s health care scheme released on wed urges the nation to establish publicly provided care as the primary vehicle for universal coverage, arguing that governance failures and fragmented delivery — rather than a lack of funding — are now the biggest barriers to health equity for 1.4 billion people.The Lancet Commission report, based on a survey of 50,000 households across 29 states, outlines a roadmap to achieve universal health coverage by 2047, the centenary of India’s independence. It concludes that while India has become a global powerhouse in vaccine and pharmaceutical manufacturing, its domestic health system is crippled by uneven quality and inefficiencies that leave millions vulnerable.“Health system reforms are not merely technical — they are profoundly political,” the report states, acknowledging that vested interests and ideological divides often stall progress.To overcome these hurdles, the commission proposed six structural reforms. It called for empowering citizens in local governance, decentralizing authority to districts, and scaling up technology to coordinate care. It also recommended shifting the public sector from a passive financier to a strategic purchaser of services, while embedding a “learning health system” culture to improve accountability. Finally, it urged engaging the private sector as a partner for universal coverage rather than ignoring it.The report’s push for public sector dominance challenges the status quo in India, where government data shows nearly half of households rely on private providers despite higher costs.“Only the public sector has historically had the mandate and mission to achieve health equity,” said co-chair Vikram Patel of Harvard Medical School. He noted that only the government possesses the necessary infrastructure, from community workers to tertiary hospitals, to reach every corner of the country.However, the commission acknowledged the private sector’s massive footprint, recommending it be aligned with national goals through “a balanced mix of incentives and regulation” rather than being sidelined. This would involve moving away from fee-for-service payments to models that reward quality and long-term disease management.The review comes as India aims for “Viksit Bharat” (developed nation) status by 2047. While the government’s Ayushman Bharat insurance scheme currently covers 600 million people, the report notes it is limited to hospitalisation, leaving families to shoulder the crushing burden of outpatient costs and medicines.“India stands at a pivotal moment,” said co-lead author Anuska Kalita. “We have a historic opportunity to transform the health system so that it truly works for every citizen.”